Re: British Accident 1sr Report Out - Thames Driver Not Being Blamed At This Point

["Derick Wuen" <cullend@webone.com.au>]

David Ready wrote in message ...
>
>For those interested the 1st interim report has been released and can be
>viewed at the BBC website. While they are saying that the Thames driver
went
>through a red that it is good that he isn't being blamed at this stage and
>that it is being seen as "a system failure". Both the BBC report and a good
>track diagram, and a link to the full report, can be seen at
>http://news.bbc.co.uk/hi/english/uk/newsid_468000/468905.stm



In UK last week and offer following on horror crash....

1. Ultimate cause of crash seems to be systemic.

(a)  At the management level, no one orgainsation has responsibility for
safety. Operators, infrastucture company, regulators (seems to be more than
one) have been "leaving it to each other". Typical inter-organisation
bureaucracy and muddle.

(b) at the engineering level, signal design, signal site and sighting, track
layout, interlocking, lack of auto train stop, all seem to contribute.

(c) very nasty PR campaign by agencies and companies involved to pass the
buck, shows all parties guilty, and worried.

2. Consensus on immediate cause seems to be Thames train committing SPAD.
Why is not known.

3. It seems to be a re-run of Southall 1997, the enquiry into which was only
just starting last week. In fact at least one GW car involved in this year's
horror was also in Southall!

I find it very difficult to assimilate the fact that I understand S109 has
been SPADDED eight times in 9 years, and nothing seems to have actually
happened except memo wars and meetings which drew up "action" lists never
implemented.

The very fact that both public and private sector bureaucrats have coined
the term SPAD is chilling enough... psychologically it downgrades the
ultimate serious rail operation error into a four-letter acronym, about
which statistics are kept but nothing else happens.... and S109 is not
alone!

My solution?

1. Reregulate safety aspects with one authority with no other duties /
conflicts of interest.

2. Install auto train stop in London metro area.

3. Any driver SPADDING gets instantly dismissed (if survives), by law.

The last may sound draconian and unfair given the poor engineering and
management, but it might make drivers slow down and look at signals before
proceeding, even at cost of disruption of operator's schedules. This would
start to hit operators where it hurts (hip pocket) and they would then
pressure infrastructure providers to lift game.

Now for an urban myth in the making.....

The was an Australian who survived the Paddington crash. A few weeks earlier
he was on the Qantas 747 which went into the golf-course at Bangkok. And a
few weeks before that he was in a serious car-crash in Australia. So maybe
we have the element which brought all the possiblities of management and
engineering failure to a head?

cheers